Lec 4: Red Lesions Flashcards
(135 cards)
1
Q
Vesicle vs. Ulcer
A
A vesicle may eventually lose the overlying epithelium and then present as an ulceration
2
Q
EPIDERMOLYSIS BULLOSA defect in?
A
Defect in the attachment mechanisms of the epithelial cells
3
Q
EPIDERMOLYSIS BULLOSA cure?
A
No cure
4
Q
EPIDERMOLYSIS BULLOSA management?
A
supportive
5
Q
EPIDERMOLYSIS BULLOSA–Vesicles and bullae due to?
A
minor trauma
6
Q
EPIDERMOLYSIS BULLOSA–oral lesions? (2)
A
Bullae may heal with scarring; restricted opening
Hypoplastic teeth
7
Q
VIRAL DISEASES onset?
A
acute
8
Q
VIRAL DISEASES symptoms?
A
May have malaise, fever, lymphadenopathy
9
Q
Lymphadenopathy not present with?
A
recurrent herpes and zoster
10
Q
Viral diseases all have?
A
vesicle stage
11
Q
Viral diseases multiple___
A
ulcers
12
Q
Spread predominantly through infected saliva or active perioral lesions
Adapted best to the oral, facial and ocular areas
Developed nations show 20% exposure at age 5 and 50-60% at adulthood
A
Herpes simplex 1
13
Q
Adapted best to genital zones
Transmitted through sexual contact, typically involving the genitalia
A
Herpes simplex 2
14
Q
Primary infection? occurs at? symptomatic or asymptomatic?
A
Initial exposure of individual without antibodies to virus
Typically occurs at young age
Often asymptomatic or subclinical
15
Q
Latency? most common?
A
Virus taken up by sensory nerves
Most common site for HSV-1 is trigeminal ganglion
16
Q
Recurrent? affect the? usually symptomatic or asymptomatic?
A
Reactivation of the virus
Affect the epithelium supplied by sensory gangilion
Usually symptomatic
17
Q
Primary Herpetic Gingivostomatitis
A
Lymphadenopathy present
Multiple vesicles and ulcers anywhere in oral cavity, pharynx, and perioral skin
May present subclinically
18
Q
Primary Herpes
A
Numerous pinhead vesicles develop
Lesions enlarge slightly and develop central ulceration
19
Q
In primary herpes, Sometimes yellow fibrin covers the ulcers, which may?
A
coalesce
20
Q
Primary herpes involves
A
keratinized and non-keratinized mucosa
21
Q
In Primary herpes, the gingiva is always enlarged and..
A
painful and extremely red
22
Q
Primary Herpes treatment?
A
Acyclovir (Zovirax)
Adults: 200mg
resolves in 10-14 days
23
Q
HERPES SIMPLEXRECURRENT HERPES aka
A
cold sore and fever blisters
Prodrome: tingling, burning, paresthesia
24
Q
RECURRENT HERPES occur in? appears on?Lymphadenopathy present?
A
small clusters;
Appears on On vermilion border, perioral skin and keratinized oral mucosal surfaces; Recur in same location each time; NO
25
HERPETIC WHITLOW (HERPETIC PARONYCHIA): due to? common in what profession?
Due to self-innoculation in children. Used to be common in dentists before gloves.
26
HERPES GLADIATORUM (SCRUMPOX): common in
wrestlers and rugby players
27
CHRONIC HERPETIC INFECTION: seen in?
immunocompromised hosts
28
TZANCK CELL?
free floating epithelial cell
29
Recurrent Herpes treatment? (2)
Medication most effective if taken at prodrome
RX: Valacyclovir (Valtrex)
Rx: Acyclovir
30
HEREPES ZOSTER (SHINGLES)-zooster represents a?
recurrence
31
Herpes Zoster (Shingles)-unilateral or bilateral?
Unilateral distribution
32
Herpes Zoster (Shingles) follows peripheral?
nerve distribution
33
Herpes Zoster (Shingles)--prognosis?
Post-herpetic neuralgia: chronic severe pain in nerve distribution after lesions resolve
34
INFECTIOUS MONONUCLEOSIS etiology?
Epstein-Barr virus (EBV, HHV-4)
35
EBV also associated with:
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Hairy leukoplakia
36
INFECTIOUS MONONUCLEOSIS-- Laboratory features?
Leukocytosis
Lymphocytosis with atypical T lymphocytes
Positive serology
37
INFECTIOUS MONONUCLEOSIS--oral mucosa?
Erythematous
Petechiae on palate
Ulcers without vesicles, later in disease
38
HAND, FOOT AND MOUTH DISEASE etiololgy?
coxsackievirus, group A
39
HAND, FOOT AND MOUTH DISEASE lesions?
Vesicles and ulcers throughout oral cavity
| Macules and vesicles on hands and feet
40
HERPANGINA etiology?
coxsackievirus, group A
41
HERPANGINA-lesions?
Similar to HFM, but confined to posterior oral cavity
| Soft palate, uvula, tonsillar pillar
42
MEASLES (RUBEOLA)--Viral infection caused by a member of the?
paramyxovirus family
43
MEASLES (RUBEOLA)--spread through?
respiratory droplets
44
MEASLES (RUBEOLA)--appearance signs?
Koplik’s spots
| “Grains of salt”
45
AUTOIMMUNE DISEASES onset? progressive? These diseases cannot be cured but can be?
Gradual onset: weeks to months; progressive; controlled with corticosteroids
46
Treatment of Non-Microbial Mucositis with Corticosteroids
Topical Steroids
Systemic Steroids
Intralesional Steroids
47
Treatment of Non-Microbial Mucositis with Corticosteroids--Topical Steroids?
Mouthrinse
Dexamethasone
Triamcinolone acetonide
Ointment
48
Treatment of Non-Microbial Mucositis with Corticosteroids--Systemic Steroids?
Prednisone: 30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QOD
49
Treatment of Non-Microbial Mucositis with Corticosteroids--Intralesional Steroids?
Triamcinolone acetonide, inject 10-40 mg
50
EROSIVE LICHEN PLANUS--cause?
Immune abnormality involving T lymphocytes
Lichenoid drug reactions
Graft-versus-host reactions
51
Erosive Lichen Planus: Oral Lesions--appearance? vesicles are? bilateral or unilateral?
white striae along periphery;
Vesicles are rare;
Bilateral; focal or generalized
52
PEMPHIGUS VULGARIS--etiology?
autoantibodies to intercellular protein in desmosomes
53
PEMPHIGUS VULGARIS--type of blisters?
Fragile blisters rupture easily forming painful ulcers
54
PEMPHIGUS VULGARIS-sign? Large areas of skin or mucosa involved; usually?
Nikolsky sign sometimes present; multifocal
55
Pemphigus Vulgaris-microscopic?
Tzanck cells
| Direct immunofluorescence on biopsy
56
Pemphigus Vulgaris- 2 biopsy specimens needed?
1 submitted in formalin
| 1 submitted in Michels solution
57
_______ Vesicle In Pemphigus Vulgaris
Intraepithelial
58
Pemphigus Vulgaris and Mucous Membrane Pemphigoid--treatment?
```
Corticosteroids
Mouthrinse
Dexamethasone
Triamcinolone acetonide
Systemic
Prednisone: 30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QOD
```
59
MUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID and Bullous Pemphigoid etiology?
antibodies against basal lamina (hemidesmosomes)
60
MUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID extraoral lesions?
Conjunctiva: may cause blindness
Nasal, pharyngeal, vaginal mucosa
Skin
61
SYMBLEPHARON
Adhesion between the bulbar and palpebral conjunctivae. May lead to blindness.
62
DESQUAMATIVE GINGIVITIS:
diffuse gingival erythema
63
Most common auto-immune blistering condition
Bullous pemphigoid
64
Compared with MMP (Mucous Membrane Pemphigoid) vs. BP (Bullous pemphigoid)
BP more limited
| No scarring with BP
65
LUPUS ERYTHEMATOSUS 3 types
Systemic lupus erythematosus (SLE)
Chronic cutaneous lupus erythematosus (CCLE)
Subacute cutaneous lupus erythematosus (SCLE)
66
Chronic cutaneous lupus erythematosus (CCLE) aka
Aka discoid lupus erythematosus
67
Chronic cutaneous lupus erythematosus (CCLE) confined to?
skin and oral cavity
68
Intermediate features between SLE and CCLE is what disease?
Subacute cutaneous lupus erythematosus (SCLE)
69
Systemic lupus--organ involvement?
May lead to kidney failure
| Cardiac involvement also common
70
LIBMAN-SACKS ENDOCARDITIS:
warty vegetations affecting the heart valves. Found at autopsy in 50% of SLE patients
71
Chronic Cutaneous Lupus--limited to? symptoms?
skin or mucosal surfaces; Scaly, erythematous patches, Scarring and pigmentation
72
CHRONIC DESQUAMATIVE GINGIVITIS presents as
diffuse sloughing of gingiva
73
Riga-Fede disease?
ulcer on tongue of neonates due to trauma from erupting teeth
74
Most common oral fungal infection in humans
CANDIDOSIS
75
CANDIDOSIS agent?
Candida albicans
76
CANDIDOSIS?
Fungal infection on the surface of the mucosa
77
Acute Erythematous Candidosis-most common or rare? symptoms? typically follow?
Most common form (more common than pseudomembranous)
Generalized pain, burning and erythema
Typically follow broad-spectrum antibiotics (“antibiotic sore mouth”)
78
What diseases is commonly seen in denture wearers, aka denture stomatitis?
Chronic Erythematous Candidiasis
79
Denture stomatitis- causes?
poorly fitting dentures, prolonged wearing of denture, poor hygiene, (may not be caused by candida)
80
What disease typically occurs with reduced vertical dimension of occlusion, but does not have to be?
Angular Cheilitis
81
Syphilis caused by?
Treponema pallidum
82
Syphilis primary symptoms?
Chancre at site of inoculation
| Solitary lesion, usually at genitalia
83
Syphilis secondary symptoms?
Maculo-papular cutaneous rash
Mucous patches
Condyloma lata
84
Syphilis tertiary symptoms?
CNS (neurosyphilis) and CV problems
85
Syphilis aka
Great imitator
86
Congenital Syphilis symptom?
Hutchinson's triad
87
Hutchinson's triad? (3)
Hutchinson’s teeth, ocular interstitial keratitis and eight nerve deafness
88
APHTHOUS ULCERS what immunologic reaction?
T-cell mediated immunologic reaction
89
APHTHOUS ULCERS types (3)
Minor, Major, and Herpetiform
90
APHTHOUS ULCERS on what type of mucosa?
non-keratinized mucosa
91
APHTHOUS ULCERS aka
canker sore
92
MINOR APTHOUS ULCERATION--size? healing time? scaring?
Size between 3-10 mm
Heal in 7-14 days
No scarring
93
MAJOR APTHOUS ULCERATION--sized? healing time? scaring?
Size between 1-3 cm
Healing in up to 6 wks
More frequent recurrence
May cause scarring
94
HERPETIFORM APTHOUS ULCERATION - size? healing time?
Size between 1-3 mm; may coalesce with one another
Heal in 7-10 days
95
Aphthous Ulcers-Microscopic features: Biopsy is not diagnostic. Diagnosis is based on history and clinical features. True or False?
True
96
APHTHOUS ULCERSTreatment for Mild and Major Aphthae ulcers?
Mild disease: topical corticosteroids
Major aphthae: more potent steroids
97
Aphthous Ulcers gives way to what syndrome?
Behcet’s Syndrome
98
Behcet’s Syndrome
Serious, multisystem disease
| Aphthous-like oral ulcers, genital ulcers, ocular inflammation, skin pustules
99
ERYTHEMA MULTIFORME cause?
unknown
100
ERYTHEMA MULTIFORME predisposing factors?
In 50% of the cases, preceded by herpes or pneumonia
| Medications: antibiotics, analgesics, sulfanomides
101
ERYTHEMA MULTIFORME forms (3)
minor, major and toxic epidermal necrolysis
102
ERYTHEMA MULTIFORME onset?
acute
103
ERYTHEMA MULTIFORME skin lesion feature?
"Iris” or “target” lesion: erythematous macule with central vesicle
104
ERYTHEMA MULTIFORME oral lesion features?
Diffuse painful ulcers: may have vesicles
| Common lips, buccal and labial mucosa
105
Stevens-Johnson syndrome (EM major):
oral and skin lesions + ocular or genital
106
Toxic epidermal necrolysis (Lyell’s disease):
diffuse sloughing of skin
107
Erythema Multiforme key clinical feature?
lesions appear suddenly
108
Stevens-Johnson Syndrome:
A more severe form of erythema multiforme
| Lesions involve skin, conjunctiva, oral mucosa, genital mucosa
109
Granulomatous lesions of the upper respiratory tract
Necrotizing glomerulonephritis
Systemic vasculitis of small arteries and veins
What disease?
GRANULOMATOSIS WITH POLYANGIITIS
110
Granulomatosis with Polyangiitis what test is done?
c-ANCA test
111
ERYTHROPLASIA symptoms?
Asymptomatic, persistent, red, or red/white lesion.
112
ERYTHROPLASIA is microscopically diagnosed as
epithelial dysplasia, carcinoma-in-situ, superficial squamous cell carcinoma
113
HHV1
Human Herpes Types 1 (HSV1)--Herpes simplex
114
HHV2
Human Herpes Types 2 (HSV2)-Herpes simplex
115
HHV3
Varicella Zoster Virus (VZV)
116
HHV4
Epstein-Barr Virus (EBV)
117
HHV5
Cytomegalovirus (CMV)
118
HHV6
Roseola virus
119
HHV7
Roseola-like virus
120
HHV8
Kaposi sarcoma herpes virus (KSHV)
121
Does recurrent herpes have lymphadenopathy?
NO
122
Is lymphadenopathy present in primary herpes?
YES
123
post-auricular lymphandenopathy
Infectious mononucleosis
124
Herpangia vs. herpes
Herpangia is only on the soft palate unlike herpes that is everywhere.
125
Measles is DNA or RNA virus?
RNA
126
Koplik's spot refers to
Measles (Rubeola)
127
Do autoimmune disease have lymphandenopathy?
NO
128
Autoimmune vs. viral disease?
Unlike viral, autoimmune diseases keep getting worse and worse as time goes on.
129
Which attacks the eyes Pemphigoid or pemphigus?
Pemphigoid
130
Murberry molars and Hutchinson's incisors are related to
syphilis
131
Primary herpes what time of tissue is it on?
keratinized AND non-keratinized
| *must be both
132
Recurrent herpes tissue?
keratinized
133
Happens acutely onset?
erythema multiforme
134
Crohn's disease-same ulcerations in colon can appear in the
mouth thus oral ulcerations
135
hemangioma aka
vascular malformation
